Individual
MS. SAMANTHA GAIL KODAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, CCRN, SRNA
Contact information
Practice address
151 RUTLEDGE AVE BLDG A, CHARLESTON, SC 29425-8903
(843) 792-3328
Mailing address
79 SHERMAN AVE, WEST ISLIP, NY 11795-3213
(631) 358-9496
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
Primary
818754
NY
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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